• 한국병원경영학회지
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• 제8권4호
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• pp.121-148
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• 2003

This study is designed to evaluate the contents of the separation of prescribing and dispensing roles(SPD) policy based on the theoretical backgrounds. The results are as follows; Considering the purpose of SPD policy, 'increasing the efficiency in manpower management by separating the role of medical doctor and pharmacist and improving the quality of SPD service through specialization of function' as a policy objective is valid and very important agenda in health care. But the objectives are not working well by no keeping the detail means to actualize it. Also, some policy objectives are unclear or inappropriate and it makes the focus of that policy obscure or misleads inadequate policy alternatives. In terms of means of policy, it is evaluated to have some limits in effectiveness, efficiency, equity, rationality, technical feasibility, economic feasibility, administrative feasibility, social and time feasibility. In conclusion, it's necessary to investigate the some problem mentioned in this paper with empirical evidence. Also, it should be needed to improve the validity of policy by correcting policy objectives and means in execution of policy.

• 한국병원경영학회지
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• 제7권3호
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• pp.84-101
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• 2002

This study estimated the influence of 'the separation of prescribing and dispensing roles' (SPD) policy, which implemented in July 2000, on the community pharmacies in Korea, by using data on the revenues and expenditures in the previous researches. We first assumed the rate of drug price differential was 20% with four different models which was based on various data of studies carried out in the similar period. Later, we applied different rates for the sensitivity analysis. According to the results, all community pharmacies made the net profit of 118.9 billion won (0.552 million won monthly per one pharmacy) after the SPD policy. The ratio of net profit to net sales dropped by 7.41%p from 22.19% to 14.78%. Additional sensitivity analysis indicated there were wide range of differences about whether net profit or net gain, and that extent which either existed.

• 한국병원경영학회지
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• 제7권4호
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• pp.1-23
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• 2002

This study examined the influence of the separation of prescribing and dispensing roles(SPD) policy implemented in Korea in July 2000, especially on the change in the net profit of medical institutions. Using the data set from the Korea's National Health Insurance and the previous research, this study elicited the following main results. First, tertiary care institutions was estimated to lose about 631 billion won after the SPD policy. Second, general hospitals and hospitals gained about 557 billion and 564 billion won, respectively. Third, it is shown that clinics also gained 389-659 billion won. Finally, however, the change in net profit of medical institutions after the SPD policy largely depends on different estimation models. Moreover, it also varies from the assumptions on the price differential of a reimbursable drug which worked as cross-subsidy to insufficient physician's fee before the SPD policy. Despite such limitations as lack of data outside of the National Health Insurance's coverage, this study differs from others. This is the first research to explore the effect of the SPD policy on different types of medical institutions and to attempt to purely focus on the SPD policy. In this study, we can draw the policy implication that preparing for a policy change, the government should set up the policy evaluation system to collect the concerned data and develop the methodologies in advance to the policy implementation.

• 대한예방의학회:학술대회논문집
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• 대한예방의학회 2002년도 제54차 추계 학술대회 연제집
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• pp.222-223
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• 2002

• 한국병원경영학회지
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• 제7권1호
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• pp.19-40
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• 2002

The purpose of this study is to find out if there has been any change in the outpatient visit to tertiary care hospitals after the introduction of the new healthcare program that divides the roles of doctors and pharmacists and the reason for the change if there is any. Two tertiary care hospitals with the largest capacity of 1200 beds and two tertiary care hospitals with the lowest capacity of 600-700 beds were randomly selected. Data of the outpatient visits from March-May 2(xx), before the new healthcare system was adopted, were compared with the data from March-May 2001, after the new policy was adopted. Outpatient visits have decreased 5.8% after the new system. There has been a dramatic decrease, especially, in the department of OB-GYN and Pediatrics of tertiary hospitals. Decrease in re-visits is much higher than the first visits. Female patients decreased more than the male patients. Outpatient visits by economically active patients group aged 25-44 declined much. Tertiary hospitals in Seoul and Kyonggi Province, as well. Outpatient income of tertiary hospitals has dropped up to 14.7% due to the decline in outpatient visits and pharmaceutical income, and resell price system which in turn has caused the hospital financial deficits. While the new program has succeeded in lowering the use of antibiotics and injections, it has the pitfall of prescribing long days and expensive drugs. A full-fledged review of the system should be conducted for the establishment of the new system and I believe this study may be a useful references. Furthermore, more profound and overall studies on the chance in the patients use of hospitals are needed.

• 농촌의학ㆍ지역보건
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• 제26권1호
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• pp.19-35
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• 2001

보건소의 의약분업 시행에 따른 업무변화와 업무 개선방안에 대해 조사 분석하여 보건소의 기능 및 역할 재정립에 필요한 기초자료를 얻고자 2001년 4월과 5월에 경상북도내 25개 보건소와 대구광역시 6개 보건소의 소장 또는 과장에게 의약분업 실시 전후의 보건소 업무 및 진료실적변화 정도를 조사하였고, 이와 함께 보건소 공무원 221명에게 의약분업에 따른 보건소 업무개선방안에 대해 설문 조사하였다. 31개 대상 보건소 가운데 77.4%인 24개 보건소가 주민진료편의 조치를 취하였다고 하였다. 주민 진료편의 조치를 한 보건소의 조치내용으로 약국배치도마련(73.9%), 인테리어 개선(39.1%), 전자처방전달시스템 도입(34.8%) 순이었다. 의약분업 실시 후 의사는 대상 보건소의 3.2%에서 감소하였다. 의약분업에 따라 월평균 진료건수는 대상 보건소의 58.1%에서 감소하였다고 하였고, 조제건수는 96.4%, 총진료비는 80.6%, 본인부담금은 80.6%, 약품구입비는 96.7%의 보건소에서 감소하였다고 하였다. 의약분업 실시 이후 진료부문에 비해 보건사업 부문의 비중은 54.2%의 보건소에서 증가하였다고 하였다. 의약분업 전후이 분기별 진료실적을 분석한 결과 진료실인원은 의약분업이전과 비교하여 의약분업 이후에 감소하였고, 진료연인원은 군보건소와 보건의료원은 감소하였으며, 시화 구보건소는 감소했다가 점차 증가하고 있다. 조제건수 총진료비 본인부담금 약품구입비는 크게 감소하였다. 보건소 공무원들은 의약분업 실시 이후 진료부문의 기능에 대해서는 57.6%가 축소시켜야 한다고 하였고, 보건소에서 우선적으로 개선해야 할 부분으로는 보건사업내용 개발(62.4%), 인력재배치(51.6%), 사업우선순위 결정(48.4%), 조직개편(36.2%), 진료서비스의 질 향상(32.1%), 예산재배치(23.1%) 순으로 응답하였다. 보건소의 이미지를 개선하기 위해서는 지역주민건강정보관리 강화(60.7%)가 가장 시급하다고 하였으며 홍보를 통한 보건소의 이용 확대(15.8%), 보건소 공무원의 친절(15.3%), 건강상담요원 배치(8.2%) 순이었다. 의약분업 실시 이후 바람직한 보건소 역할 설정을 위하여 보건소 전체 업무 영역에 대해 의약분업 이전과 이후에 상대비중을 매기도록 한 결과 25개 세부영역 중 일반진료 및 응급진료 영역만 모두 상대비중이 높아졌다. 의약분업 이후 보건소가 중점을 두어야 할 우선 순위 5위까지의 업무영역은 순서대로 예방접종, 건강증진, 모자보건, 급만성전염병, 지역보건의료계획 이었다. 향후 보건소가 바람직한 공공보건의료조직으로 기능 및 역할을 재정립하기 위해서는 의약분업이라는 중대한 보건의료환경변화를 계기로 진료부문의 기능은 축소하되 노후시설 장비의 개선, 진료방식의 다양화, 건강정보관리 강화 등 진료서비스의 내용과 질에 있어서는 강화하는 방향으로 나아가야 할 것이다. 또한 인력재배치 및 조직개편과 함께 다양한 보건사업의 개발과 지역특성에 맞는 사업우선순위에 의해 예방접조, 건강증진, 모자보건, 급 만성전염병, 지역보건의료계획 수립, 구강보건, 만성퇴행성질환 등 지역주민의 건강증진 질병예방 기능을 강화하되 지역특성(대도시, 중소도시, 농어촌)에 맞게 예방위주의 건강 증진업무와 환자 진료업무의 비중을 차별화 시키는 방향으로 개선해 나가야 할 것이다.